Pelvic Examination

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Q.What is a pelvic exam?



A. A pelvic examination is a complete physical exam of a woman's pelvic organs by a health professional. A pelvic exam helps a health professional evaluate the size and position of the vagina, cervix, uterus, fallopian tubes, and ovaries. It is an important part of preventive health care for all adult women. A pelvic exam is done to help detect certain cancers in their early stages, infections, sexually transmitted diseases (STDs), or other reproductive system problems.

Why It Is Done

A pelvic exam may be done:

• As part of a woman's regular physical checkup. A Pap smear may be done during the pelvic exam. For more information, see the medical test Pap Test.
• To detect vaginal infections, such as yeast infections or bacterial vaginosis.
• To help detect sexually transmitted diseases (STDs), such as chlamydia, herpes, gonorrhea, trichomoniasis, or human papillomavirus (HPV).
• To help determine the cause of abnormal uterine bleeding.
• To evaluate pelvic organ abnormalities, such as uterine fibroids, ovarian cysts, or uterine prolapse.
• To evaluate abdominal or pelvic pain.
• Before prescribing a method of birth control (contraception). Some methods of birth control, such as a diaphragm or intrauterine device, require a pelvic exam to make sure the device fits properly.
• Collect evidence in cases of suspected sexual assault.

How To Prepare

Before a pelvic exam:

• Try to schedule the exam when you are not having your period, since blood can interfere with the results of a Pap smear. However, if you have a new vaginal discharge or new or increasing pelvic pain, a pelvic exam may be done while you are having your period.
• Do not use douches, tampons, vaginal medications, or vaginal sprays or powders for at least 24 hours before having a pelvic exam.
• If you have an abnormal discharge, do not have sex for 24 hours before having a pelvic exam. Semen in your vagina may interfere with your exam.

At the beginning of your visit, tell your health professional:

• If you are or might be pregnant.
• If you have any reproductive or urinary tract symptoms such as itching, redness, sores, swelling, or an unusual odor or increased vaginal discharge. If you have been performing regular vaginal self-exams, discuss any changes you have noticed with your health professional. For more information, see the medical test Vaginal Self-Examination (VSE).
• If you are using a method of birth control.
• If this is your first pelvic exam.
• The first day of your last menstrual period and how long your period lasted.
• If you have had surgery or other procedures, such as radiation therapy, to the vagina, cervix, or uterus.

If you have had problems with pelvic exams in the past or are a survivor of rape or sexual abuse, talk to your health professional about your concerns or fears before the exam.

No other special preparations are needed before having a pelvic exam. For your own comfort, you may want to empty your bladder before the exam.

Talk to your health professional about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may indicate. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).

How It Is Done

During a pelvic exam, you will:

• Take off your clothes below the waist. You will have a paper or cloth covering around your waist.
• Lie on your back on an exam table with your feet raised and supported by stirrups. This allows the health professional to examine your vulva, urethra, vagina, and other reproductive organs. You may want to wear socks to keep your feet warm while they are in the stirrups.
• Have a drape across your body for privacy during the test. The health professional may use a lamp during the test, and you may ask for a mirror if you want to watch while the test is being done.

A female nurse or assistant may stay in the room with you during the exam. You may also request the presence of your partner or a friend.

External exam

During the external exam, the health professional will:

• Check your vulva and the opening of your vagina for signs of redness, irritation, discharge, cysts, genital warts, and other abnormal conditions.
• Check inside your vagina with his or her finger for any cysts or pus coming from the Bartholin glands.
• Gently insert the speculum into your vagina. The speculum spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined. The speculum may be plastic or metal and may be warmed with water or lubricated with a vaginal lubricant (such as K-Y Jelly).
• Check the walls of your vagina and your cervix for damage, growths, inflammation, unusual discharge, or discoloration.

If you are due for a Pap smear, your health professional will use a small brush or a wooden spatula to gently collect a sample of cervical cells. You may have some staining or bleeding after the sample is taken. A sample of the cervical mucus may also be obtained and tested for sexually transmitted infections such as gonorrhea or chlamydia.

Bimanual exam

This exam is usually done as part of a pelvic exam. Your health professional will insert one or two gloved fingers of one hand into your vagina while placing the other hand on your lower abdomen. By pressing down on the abdomen and moving the fingers around inside your vagina, your health professional can locate and determine the size, shape, and consistency of the uterus, ovaries, and fallopian tubes. Any unusual growths, tenderness, or pain can also be identified.

Rectovaginal exam

For this exam, your health professional will insert one finger into your rectum and one into your vagina. This helps your health professional evaluate your ovaries, fallopian tubes, and uterus ligaments. This exam is not always done as part of a pelvic exam.

The entire pelvic exam takes about 10 minutes. After the exam is finished, you will be given a washcloth or tissue to wipe your vaginal area to remove any discharge resulting from the exam, and you will then dress. Some test results may be available immediately, but results from the Pap smear may take from several days to a couple of weeks.

How It Feels

A pelvic exam is more comfortable if you and the health professional are relaxed during the procedure. Breathing deeply and having a light conversation with your health professional may help you relax. Try not to hold your breath or tense your muscles.

You may feel some pressure or mild discomfort when the speculum is inserted into your vagina. Try to relax your legs and hips as much as you can. You may experience pain or irritation, especially if you have a vaginal infection. If a metal speculum is used, the metal may feel cold and hard. The speculum may be warmed with water or lubricated with a vaginal lubricant, such as K-Y Jelly, before being inserted into the vagina.

During the bimanual part of the exam, you may feel an uncomfortable sensation of pressure or a slight twinge of pain as the health professional feels your ovaries; breathing deeply may help you relax. You may feel a brief pinch when the Pap smear is taken. Tell your health professional if any part of the exam is painful.

During the rectovaginal exam, you may feel as though you are about to have a bowel movement as the health professional withdraws a finger from your rectum. This is a normal sensation that lasts only a few seconds. You may have a small amount of vaginal discharge or bleeding after the exam.

Risks

There are no risks associated with a pelvic exam.

Results

A pelvic examination is a complete physical exam of a woman's pelvic organs by a health professional. A pelvic exam helps a health professional evaluate the size and position of the vagina, cervix, uterus, fallopian tubes, and ovaries.

Pelvic exam

Normal:	The uterus, fallopian tubes, and ovaries are normal in size and location. The uterus can be moved slightly without causing pain.
	The vulva, vagina, and cervix appear normal with no signs of infection, inflammation, or other abnormalities.
	Glands around the opening of your vagina (Bartholin's glands) or urethra (Skene's glands) are not swollen or inflamed.
	No masses (nodules) of abnormal tissue are felt in the area between the uterus and rectum (cul-de-sac) or in the strong bands of tissue (ligaments) that attach to the uterus to hold it in place. No fibroids are felt during the bimanual pelvic or rectal exams.
	No pelvic pain or tenderness is present.
	No hardening of tissue (induration) is felt.
Abnormal:	Sores, signs of infection, inflammation, or abnormalities of the vulva, vagina, or cervix are present. Signs of a sexually transmitted disease (such as genital herpes, genital warts, or syphilis) may be present. Additional testing will be required to determine the cause.
	The glands around the vagina (Bartholin's glands) or urethra (Skene's glands) are swollen or inflamed.
	The uterus cannot be moved (even slightly) during the exam.
	Pain or tenderness is felt when the uterus is moved slightly or when the area between the uterus and rectum (cul-de-sac) is touched. The uterus is pushed away from the midline of the abdomen.
	The ovaries are painful when touched, enlarged, or not movable (fixed).
	An ovarian mass is present or a mass that was detected during a previous gynecologic exam is still present or has grown larger.
	Small masses (nodules) of abnormal tissue are felt near the uterus or in the cul-de-sac. Uterine fibroids are felt during the bimanual pelvic or rectal exam.
	Hardening of tissue (induration) is felt.
	An area of ulceration or a tear is found.
	A mass can be felt near one or both ovaries.

Many conditions can change the results of your pelvic exam. Your health professional will discuss any significant abnormal results with you in relation to your symptoms and medical history.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

• Menstrual blood on the slide.
• A vaginal infection.
• The use of douches or vaginal creams or preparations within 24 hours of the exam.

What To Think About

• You should begin having regular Pap tests within 3 years after becoming sexually active. For more information, see the medical test Pap Test.
• After you have had three or more consecutive, normal annual pelvic and Pap tests, these tests may be performed less frequently, depending on your risk factors for cervical problems and the advice of your health professional.
• If a sexually transmitted disease (STD) is suspected, other specialized testing may be needed to confirm a diagnosis. For more information, see the medical tests Vaginal Wet Mount, Tests for Bacterial Vaginosis (BV), Herpes Tests, Syphilis Tests, Chlamydia Tests, and Gonorrhea Test.
• Pelvic ultrasound is another test used to evaluate a woman's pelvic organs. For more information, see the medical test Pelvic Ultrasound.
• Vaginal self-exam (VSE) may help you better understand your body, know what is normal for you, and find early signs of infections or other abnormal conditions that might require medical attention. However, VSE should supplement but not replace a regular pelvic exam and Pap test done by a health professional. For more information, see the medical test Vaginal Self-Examination (VSE).

Other Works Consulted (I needed help with this one!)

• Chernecky CC, Berger BJ, eds. (2004). Laboratory Tests and Diagnostic Procedures, 4th ed. Philadelphia: Saunders.

• Fischbach FT, Dunning MB III, eds. (2004). Manual of Laboratory and Diagnostic Tests, 7th ed. Philadelphia: Lippincott Williams and Wilkins.

• Handbook of Diagnostic Tests (2003). 3rd ed. Philadelphia: Lippincott Williams and Wilkins.

• Pagana KD, Pagana TJ (2002). Mosby’s Manual of Diagnostic and Laboratory Tests, 2nd ed. St. Louis: Mosby.

Author Sydney Youngerman-Cole, RN, BSN, RNC
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Tracy Landauer
Primary Medical Reviewer Joy Melnikow, MD, MPH - Family Medicine
Specialist Medical Reviewer Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology

Any personal health questions or problems mental or physical. Please consult your physician !

Wishing You Great Health,

Glen Edward Mitchell

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